2011-12-08T09:50:33-06:00 2010-08-31 PLANTE & MORAN PLLC 65 EAST STATE ST STE 600 COLUMBUS OH 43215 990 2010-01-01 341366258 OHIOCARE HEALTH SYSTEMS INC OHIO 4198935994 5901 MONCLOVA ROAD MAUMEE OH 43537 LORI JOHNSTON 4198935994 2011-11-16 1 BERNIE OSTROWSKI 6148493000 2010 2016-02-24 21:20:13Z X DANIEL WAKEMAN 5901 MONCLOVA ROAD MAUMEE OH 43537 9928967 0 X N/A X 1981 OH TO PROVIDE SUPPORT TO RELATED EXEMPT ORGANIZATIONS. X 13 6 147 6 0 0 4465505 2685000 3302012 7243967 0 -6338 0 0 7767517 9922629 1371954 109924 0 0 8312455 8057312 0 0 0 3632524 3988536 13316933 12155772 -5549416 -2233143 14433933 0 3218125 0 11215808 0 X NONE 0 1 9790357 0 7243967 TO PROVIDE SUPPORT TO RELATED EXEMPT ORGANIZATIONS. 9790357 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 1 0 1 1 1 1 0 0 1 30 0 1 147 1 0 0 0 0 0 0 0 0 0 0 X 13 6 0 0 0 0 0 0 0 1 1 1 0 0 1 1 1 1 1 1 1 0 OH X LORI JOHNSTON 4198247440 5901 MONCLOVA ROAD MAUMEE OH 43537 X WILLIAM R AMMANN 0.50 X X 0 0 0 DALE SEYMOUR 0.50 X X 0 0 0 DANIEL WAKEMAN 0.50 X X 0 266670 36832 DENNIS WAGNER 0.50 X X 0 104861 36381 PHYLLIS MARKS 0.50 X X 0 50137 19618 ALLAN BROGAN 0.30 X 0 0 0 BARBARA MACHIN 0.30 X 0 0 0 DAVID DEWEY 0.30 X 0 149243 44478 DEBRA BALL 0.30 X 0 123970 31110 DOUGLAS DEACON 0.30 X 0 127990 42249 JOHN BEARSS 0.30 X 0 0 0 THERESA KONWINSKI 0.30 X 0 127990 47613 THOMAS FAIRHURST 0.30 X 0 0 0 WENDY CEDOZ 0.30 X 0 0 0 MICHAEL HOEFLINGER 40.00 X 492439 0 27499 BENJAMIN SALPIETRO JR 40.00 X 494426 0 22519 THOMAS HOUSTON 40.00 X 335080 0 27389 RICHARD MARKWOOD 40.00 X 237625 0 10331 SHANNON LUCENTE 40.00 X 201690 0 5745 DAVID OPPENLANDER 0.00 X 0 0 0 1761260 950861 351764 28 0 1 0 0 2685000 2685000 PROGRAM SERVICES 900099 7102150 7102150 INVESTMENT-SURGICARE 900099 144118 144118 INVESTMENT-ST LUKE PHO 900099 -2301 -2301 7243967 6338 -6338 -6338 -6338 9922629 7243967 0 -6338 109924 109924 6894608 6067255 827353 1162704 1023180 139524 316194 316194 949995 949995 24000 24000 204718 137161 67557 1023871 1003394 20477 567518 556168 11350 87990 87990 448243 439278 8965 BAD DEBT EXPENSE 324565 324565 BANK SERVICE FEES 41442 41442 12155772 9790357 2365415 0 233328 1265029 171614 397066 234751 12132145 0 14433933 0 3107825 0 110300 0 3218125 0 X 11215808 11215808 0 14433933 0 X -2233143 -8982665 X X 0 0 0 X X X 0 0 0 ST LUKE'S HOSPITAL 344428232 3 0 0 1 0 1 0 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 9922629 12155772 -2233143 -8982665 -8982665 -11215808 PART XI, LINE 8 - OTHER ADJUSTMENTS: BOOK-TAX DIFFERENCE FROM SURGICARE K-1 156,784. BOOK VALUE OF NET ASSETS TRANSFER--SEE SCHEDULE N -9,139,449. 0 ST LUKE'S HOSPITAL 5901 MONCLOVA ROAD MAUMEE OH 43537 344428232 501(C)(3) 109924 N/A N/A GENERAL SUPPORT 0 0 0 0 0 0 0 0 0 DANIEL WAKEMAN 0 266670 0 0 0 0 0 27293 0 9539 0 303502 0 0 DAVID DEWEY 0 149243 0 0 0 0 0 35292 0 9186 0 193721 0 0 DEBRA BALL 0 123970 0 0 0 0 0 22044 0 9066 0 155080 0 0 DOUGLAS DEACON 0 127990 0 0 0 0 0 33147 0 9102 0 170239 0 0 THERESA KONWINSKI 0 127990 0 0 0 0 0 38502 0 9111 0 175603 0 0 MICHAEL HOEFLINGER 492439 0 0 0 0 0 21174 0 6325 0 519938 0 0 0 BENJAMIN SALPIETRO JR 494426 0 0 0 0 0 16194 0 6325 0 516945 0 0 0 THOMAS HOUSTON 335080 0 0 0 0 0 21064 0 6325 0 362469 0 0 0 RICHARD MARKWOOD 237625 0 0 0 0 0 5296 0 5035 0 247956 0 0 0 SHANNON LUCENTE 201690 0 0 0 0 0 5296 0 449 0 207435 0 0 0 SUPPLEMENTAL INFORMATION PART III PART I, LINE 3: COMPENSATION FOR THE ORGANIZATION'S PRESIDENT IS DETERMINED BY A RELATED ORGANIZATION, ST. LUKE'S HOSPITAL, UTILIZING A COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, WRITTEN EMPLOYMENT CONTRACT, COMPENSATION SURVEY/STUDY, AND APPROVAL BY THE BOARD AND COMPENSATION COMMITTEE. CASH 2010-09-01 20591 BOOK VALUE 344428232 ST LUKE'S HOSPITAL 5901 MONCLOVA ROAD MAUMEE OH 43537 501(C)(3) INVESTMENT IN CARE ENTERPRISES 2010-09-01 12645762 BOOK VALUE 341517671 PROMEDICA HEALTH SYSTEM 1801 RICHARDS ROAD TOLEDO OH 43607 501(C)(3) INVESTMENT IN ST. LUKE'S PHYSICIAN HOSPITAL ORGANIZATION 2010-09-01 -8398 BOOK VALUE 344428232 ST LUKE'S HOSPITAL 5901 MONCLOVA ROAD MAUMEE OH 43537 501(C)(3) INVESTMENT IN CARE HOLDINGS 2010-09-01 100 BOOK VALUE 341517671 PROMEDICA HEALTH SYSTEM 1801 RICHARDS ROAD TOLEDO OH 43607 501(C)(3) INVESTMENT IN PHYSICIAN'S ADVANTAGE MSO 2010-09-01 100 BOOK VALUE 341517671 PROMEDICA HEALTH SYSTEM 1801 RICHARDS ROAD TOLEDO OH 43607 501(C)(3) INVESTMENT IN OHIOCARE AMBULATORY SURGERY CENTER LLC 2010-09-01 937159 BOOK VALUE 344428232 ST LUKE'S HOSPITAL 5901 MONCLOVA ROAD MAUMEE OH 43537 501(C)(3) 1 1 0 0 1 1 1 1 0 0 PART I, LINE 2E: BARB MACHIN, ESQDANIEL WAKEMANDAVID DEWEYDOUGLAS DEACONTHERESA KONWINSKI PART I, LINE 2E: BARB MACHIN, ESQ, BECAME A MEMBER OF THE BOARD OF ST. LUKE'S HOSPITAL.DANIEL WAKEMAN, DAVID DEWEY, DOUGLAS DEACON, AND THERESA KONWINSKI WILL BECOME EMPLOYEES OF PROMEDICA HEALTH SYSTEM AS OF 01/01/11. CHANGES IN PROGRAM SERVICES FORM 990, PART III, LINE 3 OHIOCARE HEALTH SYSTEMS, INC. WAS DISSOLVED ON SEPTEMBER 1, 2010. FORM 990, PART VI, SECTION B, LINE 11 UPON RECEIPT OF THE COMPLETED 990 FROM THE INDEPENDENT ACCOUNTING FIRM, THE ACTING TREASURER REVIEWS THE 990. ANY ADJUSTMENTS THAT NEED TO BE MADE ARE REQUESTED PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C OHIOCARE HEALTH SYSTEMS FOLLOWS THE POLICIES OF ST. LUKE'S HOSPITAL FOR CONFLICT OF INTEREST, WHISTLEBLOWER, AND RECORD AND RETENTION AND DESTRUCTION. EVERY YEAR, CERTAIN EMPLOYEES (INCLUDING OFFICERS, DIRECTORS, AND TRUSTEES) ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST STATEMENT. FORM 990, PART VI, SECTION B, LINE 15 THE ST LUKE'S HOSPITAL BOARD OF DIRECTORS DELEGATES RESPONSIBILITY TO THE EXECUTIVE COMPENSATION COMMITTEE FOR OVERSEEING THE ST. LUKE'S HOSPITAL EXECUTIVE TOTAL COMPENSATION PROGRAM AND APPROVING ALL COMPENSATION BENEFITS ARRANGEMENTS FOR THE PRESIDENT, CHIEF EXECUTIVE OFFICER, CHIEF FINANCIAL OFFICER, AND ANY OTHER EXECUTIVES WHO MAY BE "DISQUALIFIED INDIVIDUALS" SUBJECT TO INTERMEDIATE SANCTIONS AS DEFINED BY THE INTERNAL REVENUE CODE 4958. THE EXECUTIVE COMPENSATION COMMITTEE RECOMMENDS TO THE BOARD A TOTAL COMPENSATION PHILOSOPHY FOR SENIOR EXECUTIVES AND ASSURES THAT THE TOTAL COMPENSATION PROGRAM IS ADMINISTERED CONSISTENT WITH THAT PHILOSOPHY. COMPENSATION IS DETERMINED THROUGH AN INDEPENDENT COMPENSATION CONSULTANT AND A COMPENSATION SURVEY OR STUDY. THE EXECUTIVE COMPENSATION COMMITTEE WILL ALSO BE RESPONSIBLE FOR PERIODICALLY REVIEWING TOTAL COMPENSATION POLICIES FOR NON-EXECUTIVE STAFF. FORM 990, PART VI, SECTION C, LINE 18 FORM 1023 AND FORM 990 ARE AVAILABLE UPON REQUEST. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART VII ESTIMATE OF OFFICERS' ALLOCATION OF HOURS WORKED FOR OHIOCARE HEALTH SYSTEMS, INC. RELATED ENTITIES: ST. LUKE'S HOSPITAL: -DANIEL WAKEMAN: 40 -DENNIS WAGNER: 40 -PHYLLIS MARKS: 40 -DAVID DEWEY: 40 -DEBRA BALL: 40 -DOUGLAS DEACON: 40 -THERESA KONWINSKI: 40 CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: BOOK-TAX DIFFERENCE FROM SURGICARE K-1 156,784. BOOK VALUE OF NET ASSETS TRANSFER--SEE SCHEDULE N -9,139,449. TOTAL TO FORM 990, PART XI, LINE 5: -8,982,665. FORM 990, PART XI, LINE 2C: THE AUDIT COMMITTEE OF ST. LUKE'S HOSPITAL IS RESPONSIBLE FOR THE OVERSIGHT OF THE AUDIT OF THE FINANCIAL STATEMENTS AND SELECTS THE INDEPENDENT ACCOUNTANT WHO WILL PERFORM THE AUDIT AND COMPLETION OF ANY TAX RETURNS FOR ALL OHIOCARE HEALTH SYSTEM ENTITIES. THE AUDIT IS COMPLETED ON A CONSOLIDATED BASIS. FORM 990, PART VI, SECTION A, LINE 9: DAVID M OPPENLANDER, SENIOR VICE PRESIDENT & CHIEF FINANCIAL OFFICER, CAN BE REACHED AT: DECATUR MEMORIAL HOSPITAL 2300 NORTH EDWARD STREET DECATUR, IL 62526 FORM 990, PART III, LINE 3 THE ORGANIZATION WAS DISSOLVED AS OF SEPTEMBER 1, 2010, DUE TO ITS SUBSIDIARY ORGANIZATIONS SOLE MEMBERS BEING SUBSTITUTED BY PROMEDICA HEALTH SYSTEM. FORM 990, PART VI, SECTION B, LINE 16B: THE ORGANIZATION DOES NOT HAVE A WRITTEN POLICY REGARDING JOINT VENTURES. HOWEVER, OHIOCARE DOES SAFEGUARD ITS EXEMPT STATUS WITHIN ITS JOINT VENTURE AGREEMENTS. WELLCARE PHYSICIANS GROUP LLC 5901 MONCLOVA RD MAUMEE OH 43537 611528443 PHYSICIAN PRACTICES OH 7095817 2144737 N/A ST LUKE'S HOSPITAL 5901 MONCLOVA ROAD MAUMEE OH 43537 344428232 PROVIDING HEALTHCARE SERVICES OH 501C(3) 3 N/A 1 ST LUKE'S HOSPITAL FOUNDATION 5901 MONCLOVA ROAD MAUMEE OH 43537 341292849 SUPPORTING PROJECTS TO ASSIST ST. LUKE'S HOSPITAL AND THE COMMUNITY OH 501C(3) 11B N/A 1 CARE ENTERPRISES 5901 MONCLOVA ROAD MAUMEE OH 43537 341366709 LEASE OF MEDICAL OFFICE SPACE OH 501C(3) 11B N/A 1 WATERVILLE MEDICAL CENTER LLC 5901 MONCLOVA ROAD MAUMEE OH 43537 320160784 LEASE OF MEDICAL OFFICE SPACE OH N/A CARE HOLDINGS 5901 MONCLOVA ROAD MAUMEE OH 43537 341796790 HOLDING COMPANY OH N/A C 100 0.50000 PHYSICIANS ADVANTAGE MSO 5901 MONCLOVA ROAD MAUMEE OH 43537 061811760 PHYSICIAN PRACTICE MANAGEMENT OH N/A C 100 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 ST LUKE'S HOSPITAL B 109924 CASH TRANSACTION ST LUKE'S HOSPITAL C 2685000 CASH TRANSACTION